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MS. LINDA KATHRYN WALLER LICSW, BCD, DCSW

Addiction Substance Use Disorder

Dickinson, North Dakota

Provider NPI: 1407888621

Provider Information:
MS. LINDA KATHRYN WALLER LICSW, BCD, DCSW
Gender: F
Not Sole Proprietor

Practice Location:
300 13TH AVE W STE 1  DICKINSON, ND 58601 US
Tel: 701-227-7508  Fax: 701-227-7575

Business Mailing Address:
300 13TH AVE W STE 1  DICKINSON, ND 58601 US
Tel: 701-227-7508  Fax: 701-227-7575

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
ND1593
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
ND1826

Other Provider Identifiers:

IssuerNumberStateType
BC/BS PIN12661ND01
54523ND05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS ND - Page 1



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